| Abstract|| |
Background: Haloperidol is highly effective against the positive symptoms of schizophrenia, but is less effective against the negative symptoms. It also produces marked extrapyramidal symptoms. The newer atypical antipsychotics are believed to have an equal efficacy with a favourable side-effect profile.
Aim: We assessed the effects of risperidone and haloperidol in patients with schizophrenia to compare their clinical efficacy and side-effect profile.
Methods: A double-blind, randomized, prospective, comparative trial with a parallel treatment design of 6 weeks' duration was undertaken on 46 drug-naive schizophrenics to compare the efficacy and adverse effects profile of risperidone and haloperidol.
Results: The study showed no difference in the positive and negative subscale scales on the Positive and Negative Syndrome Scale (PANSS). However, risperidone was found to have an edge over haloperidol in improving the general psychopathology as well as in bringing about global improvement.
Conclusion: Of the two drugs, the adverse effect profile of risperidone is better, with less need for the use of antiparkinsonian medication.
Keywords: Risperidone, haloperidol, drug-naive, efficacy, adverse effects
|How to cite this article:|
Vijay Sagar K J, Chandrashekar C R. A double-blind randomized trial between risperidone and haloperidol in drug-naive patients with paranoid schizophrenia. Indian J Psychiatry 2005;47:30-2
|How to cite this URL:|
Vijay Sagar K J, Chandrashekar C R. A double-blind randomized trial between risperidone and haloperidol in drug-naive patients with paranoid schizophrenia. Indian J Psychiatry [serial online] 2005 [cited 2019 Dec 10];47:30-2. Available from: http://www.indianjpsychiatry.org/text.asp?2005/47/1/30/46071
| Introduction|| |
Approximately 50% of patients with schizophrenia do not obtain adequate relief with conventional neuroleptics.  Though haloperidol is highly effective against the hallucinations and delusions of schizophrenia, it is not as useful in controlling the negative symptoms. Moreover, the potent dopamine antagonism exhibited by haloperidol is associated with a high rate of occurrence of extrapyramidal symptoms (EPS). The development of a new class of antipsychotic drugs that bind both serotonin (5-hydroxytryptamine [5-HT2]) and dopamine (D2) receptors is a major advancement. In this class, risperidone favourably evokes a lower incidence of concurrent EPS.
During the past decade, a number of double-blind trials have compared the effect of risperidone with that of haloperidol to prove its supremacy along with its favourable adverse effect profile. ,,, However, certain studies showed equal efficacy. ,,,, It is noteworthy that among these, only about 4 studies ,,, were on drug-naive patients and only one was a double-blind trial. Moreover, only a few studies were done on the Indian population and this prompted the author to take up this study to evaluate the comparative efficacy and tolerability of risperidone and haloperidol in the treatment of drug-naive schizophrenics.
| Methods|| |
The sample (n=46) was selected from the outpatient department of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore using the criteria described below.
- The age of the subjects (males and females) was in the range of 18-45 years.
- All subjects had paranoid schizophrenia.
- The subjects should not have received any antipsychotic drug.
- Informed consent was taken from the patient and/or a family member.
Patients with the following were excluded:
- Co-morbid substance dependence, mood disorder, personality disorders
- Evidence of organic conditions such as dementia and epilepsy.
Except for the level of education, the two groups did not differ on any of the other sociodemographic variables such as age, sex, place of origin, marital status, occupation, duration of illness and family history.
The selected patients were admitted and randomly grouped (23 each) to receive risperidone or haloperidol therapy and the investigator was kept blind to the assignment. At baseline, along with a complete psychiatric history and physical examination, assessment in both the groups was done using the Positive and Negative Syndrome Scale (PANSS)  and the Clinical Global Improvement (CGI) scale  for efficacy, and the Udvalg for Kliniske Undersogelser (UKU) side-effect rating scale for tolerability.  The initial daily doses of risperidone and haloperidol were 2 mg and 5 mg, respectively, which were subsequently increased as per the need, reaching a maximum daily dose of 8 mg for risperidone and 15 mg for haloperidol at the end-point.
The patients were assessed at weekly intervals for 6 weeks using PANSS, which was the key measure of antipsychotic efficacy. The primary measure of efficacy was the percentage of patients showing clinical improvement defined a priori as 20% reduction from the baseline in the total PANSS score at the end-point. The CGI scale was used to evaluate the overall status at week 3 and week 6.
The patients were also assessed every week till the endpoint using the UKU side-effect rating scale. While no other antipsychotic treatment was allowed, EPS in both the groups were treated with the antiparkinsonian drug trihexyphenidyl, as per the need.
For analysis, parametric statistical methods such as ANOVA and t test were applied. Non-parametric statistical tests in the form of the chi-square test was also applied. For the quality of variance, Levene test was used.
| Results|| |
Efficacy on PANSS
There was no difference between the two drugs in the improvement of positive and negative symptoms [Table 1].
Efficacy on the CGI Scale
Significant global improvement (p=0.05) and reduction in severity (p=0.023) were noted [Table 1].
Application of RMANOVA showed that significant differences exist between the groups with regard to sedation, increased duration of sleep, tremor, constipation, polyuria/ polydipsia and weight gain [Table 2].
Patients in both the groups needed antiparkinsonian medication (trihexyphenidyl)-12 patients in the risperidone group and 15 patients in the haloperidol group. The average dose used was 1.39 mg for the risperidone group and 1.7 mg for the haloperidol group [Table 3].
| Discussion|| |
In this randomized, double-blind, 6-week study, though marked improvement of 56% vs 48% on the positive subscale and 39% vs 23% on the negative subscale of PANSS was recorded, for risperidone and haloperidol, respectively, there was no statistical difference between the two groups. Thus, our conclusion of equal efficacy is in concurrence with the results of others studies. ,,, Better efficacy with risperidone was recorded by some authors. ,,,,,, However, in the general psychopathology subscale of PANSS and in terms of severity and global improvement on the CGI scale, risperidone showed more efficacy than haloperidol.
The majority of studies reporting otherwise, i.e. showing better efficacy of risperidone were on patients with chronic schizophrenia where negative symptoms are said to be prominent; the patients had responded more favourably with risperidone, which is known for its hallmark effect on negative symptoms. , Some noteworthy features of these studies include large sample sizes, i.e. 1362, 523 and 183, respectively and longer duration of trial, i.e. 8,12 and 16 weeks, respectively.
As in many other studies, ,,,, the present study also showed a lower incidence and severity of adverse effects. Kontaxakis et al. during their study on 17 drug-naive, first episode schizophrenic patients showed that all the patients reached the optimal dose of risperidone before developing EPS. 
The present study also evaluated the need for antiparkinsonian medication and showed that although the risperidone group needed less therapeutic intervention, it was not statistically significant between the groups. This finding concurred with the lone multicentric study by Agarwal et al. 
The merits of this study are its double-blind design, use of a flexible dosage schedule and good drug compliance. The limitations of this study include the small sample size and short duration of follow-up.
| References|| |
|1.||Kane JM. Risperidone: New horizons for the schizophrenic patient. J Clin Psychiatry 1994;55 (Suppl.):5. |
|2.||Borison R, Pathiraja A, Diamond B, et al. Risperidone: Clinical safety and efficacy in schizophrenia. Psychopharmacol Bull 1992;28:213-18. |
|3.||Chouinard G, Jones B, Remington G, et al. A Canadian multicentre placebo controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacol 1993;13:25-40. |
|4.||Marder SR, Meibach RC. Risperidone in the treatment of schizophrenia. Am J Psychiatry 1994;151:1825-35. |
|5.||Peuskens J. Risperidone in the treatment of patients with chronic schizophrenia. A multi-national, multi-centre doubleblind parallel-group study versus haloperidol. Risperidone Study Group. Br J Psychiatry 1995;166:712-26. |
|6.||Mesotten E. Risperidone versus haloperidol in the treatment of chronic psychotic patients: A multicentric, double-blind study. Janssen Research Foundation Clinical Research Report, RIS-BEL-7. August 1991. |
|7.||Claus A, Bollen K, De Cuyper H, et al. Risperidone versus haloperidol in the treatment of chronic schizophrenic patients: A multicentric double-blind comparative study. Acta Psychiatr Scand 1992;85:295-305. |
|8.||Hoyberg OJ, Fensbo C, Remvig J, et al. Risperidone versus perphenazine in the treatment of chronic schizophrenia in patients with acute exacerbations. Acta Psychiatr Scand 1993;88:395-402. |
|9.||Pappas D, Konitsiotis S, Liskos A. Risperidone in the treatment of acute schizophrenic episodes. Eur Neuropsychopharmacol 1997;7 (Suppl. 2): 206. |
|10.||Shrivastava A, Gopa S. Comparative study of risperidone and haloperidol on clinical and psychosocial parameters in treatment of schizophrenia. A randomized open trial. Indian J Psychiatry 2000;42:52-6. |
|11.||Kopala LC, Fredrickson D, Good KP, et al. Symptoms in neuroleptic-naive, first-episode schizophrenia: Response to risperidone. Biol Psychiatry 1996;39:296-8. |
|12.||Emsley RA. Risperidone Working Group. Risperidone in the treatment of first episode psychotic patients: A double-blind multicentric study. Schizophr Bull 1998;25:721-9. |
|13.||Chaudhuri BP, Bhagabati D, Medhi D. Risperidone versus haloperidol in acute and transient psychotic disorder. Indian J Psychiatry 2000;42:280-90. |
|14.||Kontaxakis VP, Kontaxakis BJH, Stamouli SS, et al. Optimal risperidone doses in drug-naive, first-episode schizophrenia. Am J Psychiatry 2000;157:7. |
|15.||Kay SR, Fisbein A, Opler LA. The Positive and Negative Syndrome Scale for schizophrenia. Schizophr Bull 1987;13: 261-76. |
|16.||Guy W (ed). ECDEU assessment manual for psychopharmacology. Publication No. ADM 76-338, Washington, DC: US Department of HE and Welfare; 1976. |
|17.||Lingjaerde O, Ahlfors UG, Bech P, et al. The UKU side effect rating scale. Acta Psychiatr Scand 1987;76 (Suppl. 334): 81-94. |
|18.||Blin O, Azorin J, Bouchours PH. Antipsychotic and anxiolytic properties of risperidone, haloperidol and methotrimeprazine in schizophrenic patients. J Clin Psychopharmacol 1996; 16:38-44. |
|19.||Bajaj P, Nihalani N, Shah N, et al. Re-emergence of positive symptoms of schizophrenia during the course of treatment with risperidone. Indian J Psychiatry 1999;41:96-9. |
|20.||Ceskova E, Svetska J. Double-blind comparison of risperidone and haloperidol in schizophrenic and schizoaffective psychoses. Pharmacopsychiatry 1993;26:121-4. |
|21.||Agarwal AK, Bashyam VSP, Channabasavanna SM, et al. Risperidone in Indian patients with schizophrenia. Indian J Psychiatry 1999;40:247-53. |
K J Vijay Sagar
Department of Psychiatry, S.V. Medical College, Tirupati 517507, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]